Auditory Hallucinations in borderline personality disorder- Are they different from those in Schizophrenia? (Psychological Medicine Sept 2012)

17.09.2012

Transient psychotic symptoms are part of the borderline PD. ( DSM 3 said” during extreme stress, transient psychotic symptoms may occur”. DSM 4 revised this to “transient, stress-related paranoid ideation“.). Clinicians consider the perceptual experiences reported by borderline PD patients as’ hallucination like’ experiences or as ‘pseudo hallucinations’.These experiences are variously  described as  quasi psychotic  thought, hysterical psychosis, psedohallucinations, hallucination like symptoms, traumatic intrusive hallucinations  etc.ie there is limited consensus on the nature of these symptoms.

It is generally thought that psychotic symptoms in BPD are short-lasting, less severe, and qualitatively different from those in psychotic disorders such as schizophrenia.

This study looked at the phenomenological characteristics and the ensuing distress of AVH ( Auditory and Visual Hallucination) in BPD and the differences between AVH in BPD and Schizophrenia.Famle patents with BPD and adult patients with Schizophrenia with AVH at least once a month for i year were recruited.substance users were excluded.Healthy females, experiencing AVH, with no current psychiatric diagnosis, were also recruited.

Findings: Patients diagnosed with BPD had experienced AVH for a long duration (mean 18 years). The majority of them experienced AVH more than once per day, with a duration of at least several minutes. The hallucinations were mostly experienced inside the head, and attributed to intracorporeal causes. Scores on the items ‘ negative content ’, ‘ distress ’, ‘ disruption of life ’, and ‘ controllability ’ were high among this group. For most of the time, the subjects experienced no control over their voices. The mean age of onset of AVH was 13, 16, and 20 years for healthy subjects, BPD, and schizophrenia, respectively. AVH experienced by the BPD group was not different from those in Schiz group phenomenologically. BPD had longer,frequent AVH than healthy AVH group.They had more distress and lower controllability.

Limitations: Largest study, but still modest numbers.Sampling bias may have occurred due to the fact that only BPD patients reporting AVH for at least once per month were included. Only females were included in this study

Clinical practice: Psychotic experiences reported by borderline PD patients need to be explored further.

It is also worthwhile to note that majority of BPD patients describe their hallucinatory experience as ‘inside the head’ and as generated ‘inside”.Clinicians often use this as a criteria to separate the hallucinatory experiences in psychosis  to those occurring in conditions like BPD.The ‘meaning’ of psychotic experiences rather than ‘presence’ itself might be the difference between these experiences . Also, earlier traumatic experiences are known to cause abnormal perceptual experiences later on,  and clinician should explore this in BPD presenting with hallucinatory experiences   to make sense them.

Auditory verbal hallucinations in patients with borderline personality disorder are similar to those in schizophrenia. Slotema CW, Daalman K, Blom JD, Diederen KM, Hoek HW, Sommer IE. Psychol Med. 2012 Sep;42(9):1873-8.

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